From an irrational fear of butterflies to a profound aversion to socialising – phobias can do more than just shake your confidence. In extreme situations, they can dictate what you do and how you do it.
Overcoming a phobia takes courage, a willingness to look what you fear most straight in the face. But when does a phobia go from an aversion to a disorder? It’s when it begins to interfere with living a normal life, says Prof. Samudra T. Kathriarachchi, Professor in Psychiatry at Sri Jayewardenepura University’s Faculty of Medical Sciences.
The body’s ‘flight or fight’ response sometimes does us a disservice in the modern world –if you are a student or an employee and you’ve faced a viva, then you may know what it feels like to have a panic attack leading to phobia, says Prof. Kathriarachchi – “you feel the same set of symptoms.” Adrenaline floods your system and your heart beat accelerates. Pupils dilate, blood sugar levels surge and muscles contract in readiness for action. Your mouth might suddenly dry out as blood vessels serving the kidney and digestive system constrict, effectively shutting down inessential systems.
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There are many variations of the theme – even your stomach might choose to revolt – and these are only compounded by the psychological symptoms. You can’t concentrate, or even think straight as your confidence crumbles. What will you do next?
Most people will struggle with the urge to simply flee the scene and do their best to ensure they never find themselves in such a vulnerable position again. As your nervousness increases, you might even find your hair standing on end.
This evolutionary response, designed to make you appear more intimidating to your attacker, is unlikely to impress your would-be boss. “The problem is that our bodies haven’t advanced as much as we have advanced socially,” explains Prof. Kathriarachchi, adding that “in the long run it can be harmful.”
Phobias, which are predictably triggered by a specific stimulus, can be part of our genetic inheritance. But “just because you have a genetic predisposition, does not mean that you’ll get it...there are environmental circumstances that can either help you develop it or overcome it,” she explains.
Many people accept their fears as a fact of life and never seek treatment.
But that’s changing slowly, as awareness spreads. Derived from the word “phobos” - Greek for ‘fear’, a phobia creates, in essence, a sense of heightened anxiety. “But if you can leave the place, if you can get away, then the anxiety is remarkably reduced,” says Prof. Kathriarachchi. However, “in the long run avoidance leads to exaggeration and persistence of symptoms,” she cautions.
Many of her patients have found solutions to phobias that help them surmount everyday obstacles. Claustrophobic individuals might choose to stand near the door of a bus, or take the stairs instead of the lift.
For some people, however, a phobia can seriously limit their options. They may choose to stay locked in their home, simply because it’s the only safe and secure place they know. Social phobia can make it difficult to interact normally in society or function effectively in the workplace. “Such people experience a fear of scrutiny,” says Prof. Kathriarachchi, explaining that while some might feel this particularly with strangers or figures of authority, it can also surface with people they know.
“This can have repercussions for their life, because in many occupations today you have to work with people and communicate effectively,” says Prof. Kathriarachchi, adding that it can sometimes even involve non-verbal situations. Some of her patients have trouble writing while under observation – their hands shake with the anxiety of being scrutinised.
Thinking your way out
Adolescents frequently experience social phobia, but most will outgrow it. “It’s quite normal in teenagers, who feel they are different and special,” says Prof. Kathriarachchi. It is only considered a disorder if it persists into adulthood. “Before that we don’t call it a disorder because these people are still developing.
We only call it a disorder when it interferes with normal life.” This interference can be observed both in the intensity and the duration of the symptoms. Like other forms of neurosis, a phobia is a mental disorder that might involve distress but neither delusions nor hallucinations. “It’s not a problem for others, it’s just for them ,” she says.
And it’s up to you to climb out of it. Despite the powerful hold a phobia has, people have been able to overcome the condition on their own. “I’ve met people who have had this social phobia but have understood it earlier on in their lives, they have done certain things to help themselves,” says Prof. Kathriarachchi counting off three steps: the first is the most essential. One must be able to identify the problem. The second is to build up the motivation to do something about it. The third is to help themselves or seek help.
The first thing to do is to prepare a list. “List out all the situations you find difficult to encounter.... from least difficult to most difficult.” You can either attempt this by yourself or with a trusted friend, but persistence is key. “Be in that anxiety, without cancelling or trying to escape it....admit, I am anxious, still I face it,” says Prof. Kathriarachchi. “Once you face it, you’ll see that gradually the anxiety gets less and less.” Slowly you will be able to work yourself up the rungs, until you are free of your phobia.
If such self therapy fails, it might be time to seek professional counselling. Both in group sessions and in individual therapy, your psychiatrist will help you. Depending on your situation, anti-depressants might be prescribed. Many psychiatrists are wary of the approach known as “flooding” where a patient is exposed to extremely high levels of the stimulus that triggers the phobia. “It’s like putting you into the deep end and expecting you to swim,” she says, “it’s not very humane.”
Nevertheless, for the nurse who is afraid of blood or the travelling businessman who must brave an aeroplane, treatment is essential. The warmth and support of family and friends during this time can be critical. Patients who are ‘rewarded’ by those around them are likely to make better progress, while those exposed to bouts of extreme criticism or over a long duration might become paralysed with insecurity and find it difficult to overcome the thing they fear.
Many are simply never given a chance, says Prof. Kathriarachchi, emphasising the roles schools can play in helping children overcome common phobias like the fear of public speaking. By focusing all events and programmes on the high achievers, other students with potential are neglected. “They too should be supported. They might prove as successful given the chance.”
Phobias -- the known ones
Medically classified as an anxiety disorder, phobias have gained acceptance in popular culture, but many of them haven’t been introduced into classification systems yet. While doctors might use the term ‘simple phobia’ to cover phobia-like fear of thunder and even of dogs, the more specific terms are not listed in medical classifications as yet.
For example, among the phobias inspired by animals are those of snakes (ophidiophobia), spiders (arachnophobia) and dogs (cynophobia). Haemophobia might make the sight of blood or an injection unbearable. There are also phobias that are situational, that come upon you in high places
(acrophobia) or near water (aquaphobia). These include the very common fear of flying (aviatophobia) and the much rarer fear of driving.
Young children frequently experience fear of their natural environment when it comes in the form of terrible thunder and lightning, but astraphobia can have an adult hiding under the blanket with the kids. Many phobias, like that of blushing (erythrophobia) and vomiting (emetophobia) defy easy categorisation.
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